A Whole9 guest post by Dr Sult, medical doctor, medical educator, inspirational speaker & the author of Just Be Well: A Book For Seekers of Vibrant Health.

In a recent post we discussed how many of us have mistakenly believed that lowering cholesterol levels is the key to reducing the risk of heart attack. In fact, tracking cholesterol levels does not get to the real culprit: LDL, or low-density lipoprotein. A high level of LDL increases the risk, while a high level of HDL, or high-density lipoprotein, lowers risk.

Doctors may prescribe statins, or cholesterol-lowering drugs, to combat dyslipidemia, or high cholesterol (i.e. high LDL). But that course of treatment may not be effective, particularly for those who have side effects from statins or who prefer alternative treatment.

A newer approach is to combine nutrition, in the form of a lipid-lowering diet, and nutraceutical supplements, which have been scientifically shown to effectively treat high cholesterol without drugs. In his article, “The Role of Nutrition and Nutritional Supplements in the Treatment of Dyslipidemia,” Mark C. Houston, MD, outlines 38 mechanisms to reduce the risk of cardiovascular disease.

Rather than tackle all 38 at once, let’s look at four nutrients that have been suggested to lower cholesterol. These nutrients are involved in the biosynthesis or elimination of cholesterol.

In the diagram below, you can see where and how these nutrients interact with the biochemical pathways that produce cholesterol. Houston’s article and the diagram below show the cholesterol pathway, beginning with the molecule acetate, which is eventually formed into a molecule generally used for energy production called Acetyl-COA.

Nutrients That Lower Cholesterol

Policosanol: A Caution

Now before we delve into the effective nutrients, I’d like to first point out one called Policosanol. Made from sugarcane extract, it’s been believed to interfere with cholesterol synthesis; however, more recent trials and my personal clinical experience have been disappointing, because using it hasn’t shown any significant improvement in lipid fraction. Although it continues to be promoted as an effective treatment for high cholesterol, it doesn’t appear to be.

Red Yeast Rice: Statin-like Results

Cholesterol medicines (like the statins, e.g. Lipitor) typically target HMG-CoA reductase, which is an important enzyme in our bodies’ production of cholesterol. Reduce the activity of the enzyme, and you’ll lower LDL cholesterol. Red yeast rice affects this enzyme. It is rice that has been fermented by red yeast (used for centuries as a preservative, spice, an ingredient in wine, and as a food coloring in dishes such as Peking duck). With many of the same active ingredients as statins, it provides a host of benefits, but also some concerns.

Studies have suggested that doses in the range of 2,400 mg per day can reduce LDL cholesterol by 22% and triglycerides by 12% without lowering the good HDL cholesterol. Red yeast rice has also been shown to reduce the risk of abdominal aortic aneurysm by suppressing another enzyme called angiotensin II. It has been shown to be effective at reducing inflammation and insulin resistance. In a mouse model, it has been effective at treating nonalcoholic fatty liver. Its anti-inflammatory properties appear to come from its ability to manage inflammatory cytokines. All of these changes have a positive effect on vascular health.

However, because this is a yeast-derived product, it can carry toxins from mold in high doses; these can be quite toxic to the kidneys. In highly purified and certified ready-to-use products, it’s important to avoid kidney damage. I suggest to my patients a dosing range from 2,400 to 4,800 mg per day.

Pantethine: Reduces LDL

If the name pantethine sounds familiar, it might be because it’s related to vitamin B5, or pantothenic acid. As a nutrient, pantethine has been shown to decrease HMG-CoA reductase, that same enzyme mentioned before that helps produce cholesterol. In one study, pantethine resulted in a 50% inhibition of fatty acid synthesis and an 80% inhibition of cholesterol synthesis. In another study, total cholesterol was decreased by 15%, LDL by 20%, the protein apolipoprotein B (a component of LDL) 27%, along with triglycerides by 36%. The effective dose is in the 300 mg three times per day range.

Tocotrienols: Reduce LDL

Tocotrienols are related to vitamin E. Vitamin E is often used to treat and prevent hardening of the arteries, heart attack and chest pain. But although some forms of vitamin E supplements contain compounds called tocopherols, they don’t contain the other form of vitamin E, called tocotrienols. Tocotrienols actually work into areas in the biosynthesis of cholesterol in several ways. The first is by inhibiting HMG-CoA reductase, and the second is by promoting an alternate pathway away from cholesterol.

When tocotrienols were added to statin medications, cholesterol was reduced an additional 10%. Patients’ carotid artery stenosis regression was reported in approximately 30% of subjects given tocotrienols for eighteen months.

Sesame: Reduces LDL

Sesame seeds have been around for centuries and may be the oldest condiment known. The nutrient has been shown to improve cholesterol numbers as well. At 40 grams per day, it was shown to reduce LDL by 9% by inhibiting intestinal re-absorption by decreased HMA-CoA reductase activity. In one trial, 26 postmenopausal women who consumed 50 grams of sesame powder daily for five weeks had a 5% decrease in total cholesterol and a 10% decrease in LDL cholesterol.

The results gained from the careful inclusion of nutrients is staggering, and not only reinforces the importance of targeting LDL, but also provides a scientific precedent for ways of treating cholesterol without prescription medicine.

But a big caution: If you’re currently taking cholesterol medicine, before you consider altering any current treatment plan, talk with your doctor about how these nutraceutical options might benefit you individually.

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Tom Sult is a medical doctor, medical educator, inspirational speaker & the author of Just Be Well: A Book For Seekers of Vibrant Health. Board-certified in family medicine & integrative holistic medicine, Tom is on faculty with the Institute for Functional Medicine and maintains a private practice in Willmar, MN. Join Tom’s crusade to change the way doctors treat their patients at www.justbewell.info. For more information on Tom’s practice please visit the 3rd Opinion website.

(Photo Credits: danielfoster437 , Alex E. Proimos / cc)